The role of common stimulus functions in the development of equivalence classes.

College students were exposed to training designed to teach nine simple discriminations, such that sets of three arbitrary visual stimuli acquired common functions. For seven of eight participants, three 3-member contingency classes resulted. When the same stimuli were presented in a match-to-sample procedure under test conditions, four participants demonstrated equivalence-consistent responding, matching all stimuli from the same contingency class. Test performance for two participants was systematically controlled by other variables, and for a final participant was unsystematic. Exposure to a yes/no test yielded equivalence-consistent performance for one participant where the match-to-sample test had not. Implications for the treatment of equivalence as a unified, integrated phenomenon are discussed

Participation as means for adaptation in dementia: A conceptual model

Maciver, Donald - ORCID 0000-0002-6173-429X https://orcid.org/0000-0002-6173-429XReplaced AM with VoR 13 Jan 2020.Objectives: There are a number of conceptual models of dementia, capturing a range of biopsychosocial factors. Few integrate the lived experience of dementia. The aim of this study was to develop a conceptualisation grounded in the first-hand accounts of living with the condition and reflecting its complexity.Method: The study was conducted within an explanatory, critical realist paradigm. An overarching narrative approach, informed by a previously completed systematic review and metasynthesis of research on the lived experience of dementia and the assumptions of complexity theory, was used to guide data collection and analysis. Data were contributed by 31 adults, including 12 people living with dementia and 19 family caregivers.Results: The experience of living with dementia was conceptualised as a process of adaptation through participation, emerging from ongoing, dynamic and nonlinear interactions between the adaptive capacity of a person with dementia and the adaptive capacity within the environment. The proposed conceptual model describes contexts and mechanisms which shape this capacity. It identifies a range of potential outcomes in dementia. These outcomes reflect interactions and the degree of match between the adaptive capacity of a person and the adaptive capacity within the environment.Conclusion: By recognising and exploring the potential for adaptation and enduring participation in dementia, findings of this research can support practitioners in facilitating positive outcomes for people affected by the condition.work completed as part of PhD process supported by Queen Margaret University Edinburgh.https://doi.org/10.1080/13607863.2019.169574025pubpub

Psychometric evaluation of the ACHIEVE assessment

AM deposited 2020-04-22. Kept embargoed till publication at author's request.Miriam Crowe - ORCID 0000-0002-8941-5442 https://orcid.org/0000-0002-8941-5442Donald Maciver - ORCID 0000-0002-6173-429X https://orcid.org/0000-0002-6173-429XReplaced AM with VoR 2020-06-12Objective: There has been a significant change within clinical practice in childhood disability from ‘treating’ at the level of body function to ecological approaches that address the child’s involvement in everyday life. Clinical assessment, and robust tools to support this, are of key importance. The aim of this study was to assess the psychometric properties of the ACHIEVE Assessment in a clinical dataset. The ACHIEVE assessment is a parent and teacher report of participation in home, school and community settings, important contributory factors for participation, and environmental factors.Design: ACHIEVE scores of children were collected from parents and teachers. The Rasch Rating Scale Model produced model estimates with WINSTEPS software.Setting: Clinical rehabilitation settings in Scotland (United Kingdom).Subjects: 401 parents and 335 teachers of 402 children participated resulting in a final sample of 736 responses. Children (78% male) were 4-17 years old (mean 7.91 years SD 2.61). Children had a range of disabilities including Developmental Coordination Disorder, Autism Spectrum Disorder, and Attention Deficit Hyperactivity Disorder.Results: The study includes a large clinical sample of children with disabilities. The results demonstrate that the ACHIEVE Assessment can provide unidimensional measurements of children’s participation and important contributory factors for participation. Differential item functioning analysis indicated majority of items were comparable between parent and teacher report.Conclusions: The results confirm evidence of appropriate psychometric properties of the ACHIEVE Assessment. ACHIEVE is a comprehensive tool that enables identification of patterns and issues around participation for clinical and research purposes.https://doi.org/10.3389/fped.2020.002458pubpu

Exploring the needs of people with dementia living at home reported by people with dementia and informal caregivers: A systematic review and meta-analysis

Maciver, Donald - ORCID 0000-0002-6173-429X https://orcid.org/0000-0002-6173-429XReplaced AM with VoR 09 Jan 2020Curnow, Eleanor - ORCID 0000-0001-9332-8248 https://orcid.org/0000-0001-9332-8248Objectives: To provide prevalence estimates of needs of people with dementia living at home, and to determine sources of variation associated with needs for this population.Method: A systematic review and meta-analysis was performed searching CINAHL, MEDLINE, PsycINFO and ASSIA databases. Following quality checks, random effects meta-analysis produced prevalence estimates for needs reported by people with dementia and by their informal caregivers. Fixed effects models were undertaken to compare caregiver and person with dementia reported needs. Heterogeneity was explored through sensitivity analysis. The study protocol was registered with Prospero #CRD42017074119Results: Six retrieved studies published between 2005 and 2017 including 1011 people with dementia and 1188 caregivers were included in the analysis. All data was collected using Camberwell Assessment of Need for the Elderly. Prevalence estimates are provided for 24 needs reported by participants in The Netherlands, United Kingdom, Poland, Ireland, Germany, Norway, Portugal, Italy and Sweden. Most prevalent needs reported by people with dementia were Memory 0.713 [95% CI 0.627, 0.791]; Food 0.706 [95% CI 0.547, 0.841]; Household activities 0.677 [95% CI 0.613, 0.738]; and Money 0.566 [95% CI 0.416, 0.711]. Caregivers reported greater prevalence than people with dementia did for 22 of 24 needs, although the priority ranking of needs was similar. Exploration of heterogeneity revealed that people with young onset dementia were the major source of variation for 24 out of 44 analyses.Conclusion: Increased understanding of prevalence of needs of people with dementia and associated heterogeneity can assist in planning services to meet those needs.https://doi.org/10.1080/13607863.2019.169574125pubpub

Living With Dementia: A Meta-synthesis of Qualitative Research on the Lived Experience

Purpose of the Study: To identify and examine the published qualitative research evidence relative to the experience of living with dementia. Design and Methods: Metasynthesis was used as the methodological framework to guide data collection and analysis. Results: Three themes were identified. The first theme considered the main condition-related changes experienced by people with dementia (PWD) and showed how these are interlinked and impact upon various areas of people's lives. The second theme indicated that amidst these changes, PWD strive to maintain continuity in their lives by employing various resources and coping strategies. The third theme underlined the role of contextual factors. The reviewed evidence indicates that, the emerging experience of PWD and their potential to adjust to the continuous changes is influenced by access to and quality of both personal and contextual resources which remain in a constant, transactional relationship to each other. Implications: The findings were interpreted and discussed in the context of relevant theoretical frameworks and research evidence. It was considered that current evidence and findings presented in this review can be further explored and expanded upon in a more systematic way through research conducted within the theoretical framework of dynamic systems theory. Further research would be also beneficial to explore the subjective experience of dementia from a participatory perspective. Exploring the application of these theoretical standpoints would contribute to the current state of knowledge and offer both PWD and carers fresh perspective on the nature of change and potential for adaptability in dementia.sch_occ58pub4643pub

Incite to practice: Development of a realist-informed program theory to support implementation of intersectoral partnerships

Donald Maciver - ORCID: 0000-0002-6173-429X https://orcid.org/0000-0002-6173-429XPolicy internationally is supportive of intersectoral partnerships (ISPs) for promoting positive outcomes among people with complex social, psychological, and physical needs. This realist-informed study describes the development of a program theory to provide insight into enactment of effective ISPs. Interviews were completed with 18 senior staff with leadership roles in six ISPs, including voluntary, statutory, and commercial organizations, supporting people with complex health and social care needs. An iteratively developed and refined program theory, termed the “Incite” model, was developed, with collaboration with participants and an advisory group, including people with lived experience. Important contextual conditions that emerged included organizational culture, historical perspectives, policy, and social determinants of health. Mechanisms included desire for change, creating safe psychological spaces, establishing shared values, and talking about power. Outcomes included transformed world view, increased psychological safety, clarity of purpose, fluidity of relationships, and power shifting. Three phases of partnership development were also identified within the model. This study has led to a clearer, more rigorous, and systematic understanding, with recommendations for how ISPs might be developed or expanded. How the Incite model may be operationalized is discussed, as well as implications for policy, practice, and research.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: We acknowledge funding contributions from the Scottish Government’s Third Sector Division and Mental Health Division and Community Covenant Grant.https://doi.org/10.1177/2158244021103831611pubpub

Using stakeholder involvement, expert knowledge and naturalistic implementation to co-design a complex intervention to support children’s inclusion and participation in schools: The CIRCLE framework

Donald Maciver - ORCID: 0000-0002-6173-429X https://orcid.org/0000-0002-6173-429XReplaced AM with VoR 2021-03-16Whist inclusion is recommended for most children most of the time it remains difficult to implement. In this paper, we present the process undertaken to review and redesign a pre-existing complex intervention (The CIRCLE Framework) which was designed to enhance teachers confidence and competence in provision of universal first level supports for 5-12 year old children with additional support needs. The approach presented draws on the Medical Research Council guidance for the development of complex interventions. A series of ten co-design workshops with 70 stakeholders was completed, applying interactive and participatory methods. Analysing outputs of each workshop revealed recurring design ideas that became the main aspects of the new framework and associated manuals. Intervention content, theoretical frameworks, manuals to support use in practice and implementation strategies were developed. On completion, the updated intervention was extended up to 18 years of age and redistributed to all teachers in the participating local authority. We present the main conclusions and interpretations around the design and naturalistic implementation of the framework, and reflections on use in practice, including a detailed list of recommendations for implementation across schools and staff.Funding: This work was supported by the City of Edinburgh Council.https://doi.org/10.3390/children80302178pubpub

Convergent approach to persistent atrial fibrillation ablation:long-term single-centre safety and efficacy

Background:Efforts to maintain sinus rhythm in patients with persistent atrial fibrillation (PsAF) remain challenging, with suboptimal long-term outcomes.Methods:All patients undergoing convergent PsAF ablation at our centre were retrospectively analysed. The Atricure Epi-Sense® system was used to perform surgical radiofrequency ablation of the LA posterior wall followed by endocardial ablation.Results:A total of 24 patients underwent convergent PsAF ablation, and 21 (84%) of them were male with a median age of 63. Twelve (50%) patients were obese. In total, 71% of patients had a severely dilated left atrium, and the majority (63%) had preserved left ventricular function. All were longstanding persistent. Eighteen (75%) patients had an AF duration of >2 years. There were no endocardial procedure complications. At 36 months, all patients were alive with no new stroke/transient ischaemic attack (TIA). Freedom from documented AF at 3, 6, 12, 18, 24, and 36 months was 83%, 78%, 74%, 74%, 74%, and 61%, respectively. There were no major surgical complications, with five minor complications recorded comprising minor wound infection, pericarditic pain, and hernia.Conclusions:Our data suggest that convergent AF ablation is effective with excellent immediate and long-term safety outcomes in a real-world cohort of patients with a significant duration of AF and evidence of established atrial remodelling. Convergent AF ablation appears to offer a safe and effective option for those who are unlikely to benefit from existing therapeutic strategies for maintaining sinus rhythm, and further evaluation of this exciting technique is warranted. Our cohort is unique within the published literature both in terms of length of follow-up and very low rate of adverse events

An enhanced individual placement and support (IPS) intervention based on the Model of Human Occupation (MoHO); a prospective cohort study

Susan Prior - ORCID 0000-0003-3069-6961 http://orcid.org/0000-0003-3069-6961Donald Maciver - ORCID 0000-0002-6173-429X https://orcid.org/0000-0002-6173-429XKirsty Forsyth - ORCID 0000-0002-6732-1699 https://orcid.org/0000-0002-6732-1699Replaced original VoR with updated VoR 2020-07-09Background: Employment is good for physical and mental health, however people with severe mental illness (SMI) are often excluded from employment. Standard Individual Placement and Support (IPS) is effective in supporting around 55% of people with SMI into employment or education. Current research considers enhancements to IPS to improve outcomes for those requiring more complex interventions. Clinicians need to better understand who will benefit from these enhanced IPS interventions. This study offers a new enhanced IPS intervention and an approach to predicting who may achieve successful outcomes.Methods: This prospective cohort study included people with SMI who participated in an enhanced IPS service and had prolonged absence from employment. Secondary data analysis was conducted of data gathered in routine clinical practice. Univariate analysis coupled with previous research and clinical consultation was used to select variables to be included in the initial model, followed by a backward stepwise approach to model building for the final multiple logistic regression model with an outcome of successful or unsuccessful goal attainment (employment or education).Results: Sixty-three percent of participants in the enhanced IPS successfully attained employment or education. Significant relationships from bivariate analyses were identified between outcomes (employment or education) and seven psychosocial variables. Adapting Routines to Minimise Difficulties, Work Related Goals, and Living in an Area of Lesser Deprivation were found to be significant in predicting employment or education in the final multiple logistic regression model R2 = 0.16 (Hosmer-Lemeshow), 0.19 (Cox-Snell), 0.26 (Nagelkerke). Model χ2(7) = 41.38 p < .001.Conclusion: An enhanced IPS service had a 63% rate success in achieving employment or education, higher than comparable studies and provides an alternative to IPS-Lite and IPS-standard for more complex populations. Motivational and habitual psychosocial variables are helpful in predicting who may benefit from an enhanced IPS intervention supporting people after prolonged absence from employment.Trial registration: NCT04083404 Registered 05 September 2019 (retrospectively registered).This study was funded by the Scottish Government. The funding body had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.https://bmcpsychiatry.biomedcentral.com/https://doi.org/10.1186/s12888-020-02745-320pubpu

Development and implementation of the CIRCLE Framework

Donald Mciver - ORCID: 0000-0002-6173-429X https://orcid.org/0000-0002-6173-429XAcknowledgements: Thanks are due to the Head Teachers and staff from the participating schools. Thanks to the City of Edinburgh Council’s Additional Support for Learning Service and to Martin Vallely, Professional Services Manager.This is an Accepted Manuscript of an article published by Taylor & Francis in International Journal of Disability, Development and Education on 12 Jul 2019, available online: https://www.tandfonline.com/doi/full/10.1080/1034912X.2019.1628185We report the implementation of a new framework supporting teacher practice for inclusion of children with disabilities in mainstream classrooms. Eight schools in one Scottish authority took part. Questionnaire, focus group and interview data were gathered. Results indicated that the framework was well-received and provided a useful resource for class teachers. The framework was perceived as a feasible method for supporting teachers and related personnel to think systematically about key issues relating to children with disabilities in the classroom. It was suggested that provision of a common language was supportive of collaborative working. Areas for revision included a system of navigation and simplification in the framework manual.67pubpub